McDonel E C, Bond G R, Salyers M, Fekete D, Chen A, McGrew J H, Miller L
Indiana University at Bloomington, USA.
Adm Policy Ment Health. 1997 Nov;25(2):153-73. doi: 10.1023/a:1022286921362.
The authors present a controlled evaluation of a rural adaptation of the assertive community treatment (ACT) model for clients with serious and persistent mental illness (SPMI). Four community mental health settings adopted an ACT model, while a fifth site blended ACT principles with those of the Rhinelander model, another approach to case management for persons with SPMI. A broad array of client and system outcomes were evaluated at 6, 12, and 24 months into the intervention. Twelve-month findings alerted us to potential problems in implementing the treatment model in study year 1; the implementation was qualitatively evaluated and weaknesses were addressed at the beginning of the second treatment year. Small, positive findings at 24 months suggested that the mid-study course correction may have had an impact. We present these findings along with descriptive data on the challenges of implementing complex services models. We give particular attention to describing implementation barriers to mental health services provision that are uniquely rural.
作者对针对严重持续性精神疾病（SPMI）患者的积极社区治疗（ACT）模式的农村适应性进行了对照评估。四个社区心理健康机构采用了ACT模式，而第五个机构将ACT原则与莱茵兰德模式（另一种针对SPMI患者的病例管理方法）的原则相结合。在干预的6个月、12个月和24个月时，对一系列广泛的患者和系统结果进行了评估。12个月的研究结果使我们意识到在研究的第一年实施该治疗模式时可能存在的问题；对实施情况进行了定性评估，并在第二个治疗年开始时解决了不足之处。24个月时的微小积极结果表明，研究中期的过程调整可能产生了影响。我们展示了这些结果以及关于实施复杂服务模式所面临挑战的描述性数据。我们特别关注描述农村地区在提供心理健康服务方面独特的实施障碍。
